Of the four lifestyle changes prescribed to bariatric patients following weight loss surgery Rule #4, Daily Exercise, is the most difficult for patients to incorporate in their weight loss program. Patients who undergo weight loss surgery are morbidly obese at the time of surgery and most often have been living a sedentary lifestyle due to mobility complications caused by their weight. The surgeon's advice to include daily exercise as part of a weight loss program can feel as daunting as the challenge to climb Mt. Everest. In addition to daily exercise weight loss surgery patients are prescribed a high protein diet, and they must drink lots of water and avoid snacking.

Patients are more likely to become physically active when they gently increase their Activities of Daily Living (ADLs) rather than a attempt a full-steam-ahead boot camp-style cardio and strength training regimen from the get-go. The well-known Duke Diet for healthy and lasting weight loss suggests that the first element of fitness is the ADLs which include everything from "waking up, getting out of bed, combing your hair, putting on your robe, stepping out to get the newspaper to doing household chores, taking care of the yard, and walking the dog." According to the Duke Diet program ADLs accumulate throughout the day and burn calories with little or no conscious effort.

During the early days and weeks of recovering from bariatric surgeries, including gastric bypass, adjustable gastric banding (lap-band), and gastric sleeve, patients are encouraged to walk short distances several times a day as part of their recovery program. As a person heals from surgery they can mindfully seek opportunities throughout the day to increase their ADLs in ways that morbid obesity had limited them before surgery and the resulting weight loss. Patients should avoid the mistake many have fallen to, that is "waiting until I lose the weight before I start exercising." Patients who wait to include exercise in their day or fail to increase their ADLs seldom achieve the desired goal weight or sustain the weight loss full term.

Consider these opportunities to increase Activities of Daily Living while recovering from gastric weight loss surgery:

Do moderate housework like vacuuming and sweeping more frequently and more energetically During TV commercial breaks stand and walk in place, do stretches, knee bends, or arm circles Take the dog for longer, more frequent walks Play actively with children and include brisk walking, bending, tossing or climbing movements at the park or playground Enthusiastically work in the garden mowing the lawn or raking leaves Use stairs instead of elevators or escalators going both up and down Take stretching breaks to loosen tight muscles during long working days at a desk or office job Stand for routine office tasks like sorting paperwork or filing and talking on the phone Do calf raises while standing on line or waiting for the bus Plan hometown walking tours for a leisurely afternoon and explore your neighborhood Bring groceries from the car into the house one bag at a time increasing steps, do arm curls with heavier items like canned goods before putting away Hand wash the car with a bucket of sudsy water and rinse with the garden hose instead of going to a drive through car wash to increase activity and save money

The benefits of increased Activities of Daily Living are twofold for weight loss surgery patients: the first benefit is that of increased physical mobility and stamina; the second benefit is enjoying activities which morbid obesity had prevented. As patients become stronger physically through increased ADLs and weight loss they can then, quite effectively, begin to add fitness-building activities to their healthy weight management routine.